Automatic prescription drug dispenser

ABSTRACT

An automatic prescription drug dispenser including a remote dispenser, a prescription entry system, and a communications network. The remote dispenser transmits and receives information from the communications network and dispenses prescription drugs to the patient. The prescription entry system transmits and receives information from the communications network and provides an input system for the prescriber to electronically enter individual prescriptions for each patient. The communications network coordinates communications between the doctor, insurance carrier, and the remote dispenser. The remote dispenser stores, retrieves, and labels prescription drug and over-the-counter products directly to patients through a remote automated dispenser, a prescription entry system, and a communications network. The remote dispenser transmits and receives information from the communications network and dispenses drugs to the patient. The prescription entry system transmits and receives information from the communications network and provides an input system for the doctor to electronically enter individual prescriptions for each patient. The communications network coordinates communications between the prescriber, insurance carrier, and the remote dispenser. Also described are various embodiments of apparatus and method of the invention useful in pharmacy settings as for example found in drug stores or “big box” retailers or other such settings. Other methods include providing a remote dispenser in virtually any location.

PRIORITY OF INVENTION

This application is a continuation application of U.S. application Ser.No. 11/821,004, filed Jun. 21, 2007, which is a divisional applicationof U.S. application Ser. No. 10/852,010, filed May 24, 2004, which is adivisional application of U.S. application Ser. No. 10/229,923, filedAug. 27, 2002, which claims priority of invention under 35 U.S.C. §120from U.S. application Ser. No. 09/714,802, filed Nov. 16, 2000, which isa nonprovisional application filed under 35 U.S.C. § 119(e) of U.S.Provisional Application No. 60/210,303 filed Jun. 8, 2000, all of whichare incorporated herein by reference in their entirety.

TECHNICAL FIELD

The present invention concerns dispensing systems, such as vendingmachines, particularly dispensing systems for prescription drugs.

BACKGROUND

U.S. application Ser. No. 09/714,802 describes a prescription medicationdispensing machine capable of, among other things, automaticallylabelling a medication for dispensing to a specific patient in responseto electronic prescription data supplied to the machine. Thisapplication presents various applications and improvements to theembodiments illustrated in U.S. Ser. No. 09/714,802. In particular, butnot limited thereto, the present application describes applications andalternate embodiments of the apparatus particularly useful in pharmacysettings in drug stores or other establishments like “big box”retailers.

SUMMARY

The present discussion includes a number of different method andapparatus embodiments useful in, among other things, the dispensing ofprescription medications at a pharmacy that may or may not be staffedwith live pharmacy personnel during some or all of its operating hours.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a schematic diagram of a high-level computer systemarchitecture according to one embodiment.

FIG. 2 is a schematic diagram of a software architecture embodiment ofthe remote dispenser according to one embodiment of the presentinvention.

FIG. 3 is a schematic diagram of a process by which a patient is seen bya prescriber, receives a prescription, and has the prescription filledby the remote dispenser according to one embodiment of the presentinvention.

FIG. 4 is a schematic diagram of a patient registration processaccording to one embodiment of the present invention.

FIG. 5 is a schematic diagram of a prescription writing processaccording to one embodiment of the present invention.

FIG. 6 is a schematic diagram of a patient discharge process accordingto one embodiment of the present invention.

FIG. 7 is a schematic diagram of a process of modifying an establishedprescription according to one embodiment of the present invention.

FIG. 8 is a schematic diagram of a process of ordering stock for eachremote dispenser according to one embodiment of the present invention.

FIG. 9 is a detailed schematic diagram of the process of ordering stockfor each remote dispenser according to one embodiment of the presentinvention.

FIG. 10 is a schematic diagram of a process by which a patient has aprescription filled by the remote dispenser according to one embodimentof the present invention.

FIG. 11 is a front view of a remote dispenser according to oneembodiment of the present invention.

FIG. 12 is a side cross sectional view of a remote dispenser accordingto one embodiment of the present invention.

FIG. 12B is a front view of a remote dispenser according to oneembodiment of the present invention.

FIG. 13 is a front cross sectional view of a remote dispenser accordingto one embodiment of the present invention.

FIG. 14 is an exploded perspective view a magazine and lead screw systemaccording to one embodiment of the present invention.

FIG. 15 is a front view of a gantry transport system according to oneembodiment of the present invention.

FIG. 16 is a front view of a y-axis system of the gantry transportsystem according to one embodiment of the present invention.

FIG. 17 is a cross sectional view of a y-axis system according to oneembodiment of the present invention.

FIG. 18 is a perspective view of an end effector according to oneembodiment of the present invention.

FIG. 19 is a side view of a product rotator according to one embodimentof the present invention.

FIG. 20 is an end view of the product rotator according to oneembodiment of the present invention.

FIG. 21 is a perspective view of a label printer assembly according toone embodiment of the present invention.

FIG. 22 is a perspective view of a moveable printer according to oneembodiment of the present invention.

FIG. 22B shows a perspective view of portions of a dispenser accordingto one embodiment.

FIG. 22C shows a perspective view of a product delivery chute accordingto one embodiment.

FIGS. 23-30 are screen views of one embodiment of a prescription entrysystem for a handheld computing device.

FIGS. 31-47 illustrate additional embodiments of systems, methods andconfigurations for use of medication dispensing machines according tothe present invention.

FIG. 48 illustrates an alternate embodiment of a dispensing machineaccording to the present invention.

FIG. 49 illustrates a dispensing system according to one embodiment.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

The following detailed description, which references and incorporatesthe Figures, describes and illustrates one or more specific embodimentsof the invention. These embodiments, offered not to limit but only toexemplify and teach the invention, are shown and described in sufficientdetail to enable those skilled in the art to practice the invention.Thus, where appropriate to avoid obscuring the invention, thedescription may omit certain information known to those of skill in theart.

The automatic prescription dispensing system provides safe, convenientand immediate prescription drug service to patients in primary, urgent,acute, and emergency care settings. Further examples provideprescription drug service to patients in pharmacies, either with orwithout the intervention of a pharmacist. The system can be used invirtually any location, such as doctor's office, a kiosk in a mall, or abus station, for example. The system can deliver prescribed medication,over-the-counter (OTC) medication, and medical supplies, such assyringes. Some embodiments can deliver virtually any dispensable orvendible product.

The system provides several advantages including, but not limited to,entry of a prescription into a handheld computer using a unique softwareapplication, downloading of prescription and patient data from a centralserver database, acceptance of credit, debit, smart and ATM cards, cash,or check. The system includes automatic verification by barcode of eachdrug package for correct drug and expiration date before dispensing,optional prescription print-out instead of dispensing the prescriptiondrugs, dispensing of appropriate drug education information and paymentreceipts, transfer of information to and from a central server databaseregarding available product information, restocking, product returns,prescription-filled and prescription-printed flags, patient requests forautomatic refills and refill reminders, failure information, the abilityto alert the central server if security of the dispensing system iscompromised, and other miscellaneous two-way information transfersbetween a patient and a central control via a touch screen or otherinterface.

System Architecture

FIG. 1 is a schematic diagram of a high-level computer systemarchitecture embodiment of the invention. The system 1000 is adistributed network comprising a central server 2000, a remote dispenser3000, and one or more prescription and patient data entry systems suchas HCF system 4000. A patient who visits a physician or other providerat a healthcare facility (HCF), such as a clinic, where an HCF system4000 (or other prescription entry system) is located receives aprescription that is filled at the remote dispenser 3000 if theprescription is so authorized, or adjudicated (if there is no insurance,the prescription need not be adjudicated), by central server 2000. Todecide whether to authorize the prescription, central server 2000 is indistributed network communications with the adjudication system 5000, apayment authorization system 6000, such as a credit card authorizationsystem, a check verification system 6000A, or other payment scheme, amail order system 6999, a prescription bottler system 7000, and a drugformulary update service 8000. Here, adjudication system 5000 routes anyinsurance claims to third-party payors 9000 (TPP). If a claim is deniedby the TPP, the rejected claim is routed to a call center 9050. The callcenter 9050 analyzes the rejection and views scanned insurance cardimages. After any corrections are made, the claim is resubmitted or theprescription is printed for the patient. The call center 9050 can alsobe in communication with the clinic and with a user via a phone or othercommunications means at remote dispenser 3000.

Central Server

Central server 2000 captures all data that is created by the variousother components of the system 1000. It also prepares, sends, andreceives all adjudicated claims; prepares, sends, and receives allcredit card, cash, or check payments; and retains inventory data for allremote dispensers.

An example of the hardware and software that are suitable for thecentral server 2000 is a Compaq Prolient 1800 computer system 2100 thatis expandable to dual processors, one gigabyte of SDRAM central memory,and 250 gigabytes of SCSI hard drive storage 2200; Microsoft Windows NTServer 4.0 operating system; and Microsoft SQL Server 7.0 database.Other generally equivalently performing hardware and software could besubstituted in a known manner without limiting the scope of theinvention. In accordance with known principles, the design of the systemshould be such that the system functions are not dependent upon theparticular hardware or software selected for implementation, thuspermitting the system to migrate to other hardware or software platformswithout any change in the scope of the invention.

A software application running on the central server 2000 is responsiblefor setting up authorized HCF systems 4000 and prescribers ofprescriptions. This application is preferably written in Java fordisplay in an Internet browser application running on a client of thecentral server 2000 or a HCF system 4000 (assuming appropriateauthorization criteria are met).

Another software application running on the central server 2000 isresponsible for generating reports to document the operation andperformance of system 1000 in accordance with well-known principles.Reports are preferably created on central server 2000 and sent to aprinter anyplace on the network for generation of hard copy. Acommercially available report generation system, preferably but notnecessarily Crystal Reports, may be used to format the report data inaccordance with well-known principles.

Another software application running on the central server 2000 isresponsible for processing transactions associated with the adjudicationof valid prescriptions (if necessary). A commercially availableadjudication application, preferably but not necessarily Claims Engine2000, may be used in accordance with well-known principles to exchangedata between central server 2000 and adjudication system 5000.

Another software application running on the central server 2000 isresponsible for packaging, sending and receiving credit card, cash,check, or other type payment and reversal transactions generated bypatients who must pay for the prescriptions they receive. A commerciallyavailable but proprietary authorization application, provided by thecredit card vendor(s), may be used in accordance with well-knownprinciples to exchange data between central server 2000 and credit cardauthorization server 6000. In the same manner, check authorization canbe performed using a system such as Telecheck, using a service such aselectronic check acceptance (ECA).

Another software application running on the central server 2000 isresponsible for monitoring the inventory levels of the various productsdispensed from each of the remote dispensers 3000. In accordance withknown principles, monitored inventory levels are used to determinereorder points (times and quantities) for the products. This applicationalso determines which National Drug Code (NDC) is used to adjudicate theprescription when a particular product is prescribed. The application ispreferably written in Java for display in an Internet browserapplication. The application will run both on the central server 2000and on the HCF workstation 4200. Optionally, inventory levels aremonitored by the remote dispenser 3000. The central server 2000 providesvendor and product information and the remote dispenser 3000 wouldinteract with the vendors and perform the inventory control functions.Summary reports are uploaded to the central server 3000.

Another software application running on the central server 2000 isresponsible for importing and maintaining the drug information. Thepreferred method is to import and maintain drug data files 8000 providedby First Databank (FDB), using an application written in Java and usingthe FDB toolkit provided by the vendor.

Another software application running on the central server 2000 isresponsible for setting the price of products dispensed from remotedispenser 3000. The preferred embodiment is a program written in Java.

Remote Dispenser

FIG. 2 is a schematic diagram of the software architecture of the remotedispenser 3000. From a software standpoint, remote dispenser 3000comprises two major subcomponents, dispenser module 3100 and managermodule 3200, which communicate with each other in any well-known manner.

Dispenser module 3100 controls the actual dispensing of the product fromthe remote dispenser 3000. Given properly verified data, dispensermodule 3100 will dispense properly labeled product. To do so, it issuesappropriate commands to motor 3125, scanner 3150 and label printerdriver 3925 based on communications with manager module 3200 and localcache 3300.

Manager module 3200 is the main controller of remote dispenser 3000. Itcoordinates and controls the interaction between all of the otherhardware and software components of the remote dispenser 3000. Itcommunicates with dispenser module 3100, local cache 3300, userinterface 3400, server interface 3500, power monitor 3600, temperaturemonitor 3700, cash handler or debit, ATM, smart, or credit card readerdriver 3800, or a check reader 3825, or a cash acceptor 3830 and changereturn 3835, and prescription/receipt printer driver 3900.

Local cache 3300 is responsible for storing and retrieving data in localstorage 3350. The local cache 3300 manages data related to productinventory, system configuration, and advertising. It communicates withdispenser module 3100 and manager module 3200 as required. Local storage3350 is any appropriate data storage device performing typical datastorage and handling in a well-known manner.

User interface 3400 is responsible for interacting with patients andmaintenance personnel. It controls the screen display shown on visualmonitor 3450, and also manages timeouts that can be encountered at eachstep of the process of using remote dispenser 3000.

Server interface 3500 is responsible for communications with the centralserver 2000. It will send and receive data between the remote dispenser3000 and the central server 2000. It is also responsible for translatingdata to and from formats required by the remote dispenser 3000 andcentral server 2000.

Power monitor 3600 monitors the normal line voltage power supply toremote dispenser 3000 and activates uninterruptible power supply (UPS)3650 as required.

Temperature monitor 3700 monitors the ambient temperature inside remotedispenser 3000 with a temperature sensor 3750.

Card reader driver 3800 allows manager module 3200 to operate acommercially available cash handler, ATM, smart debit or credit cardreader 3850 in a well-known manner.

Check reader 3825 can be a check reader such as a check readerdistributed by Magtek Inc. As discussed above, the check reader can beoperatively coupled to central server 2000 to allow for checkauthorization to be performed using a system 6000A, such as Telecheck,using a service such as electronic check acceptance (ECA).

Prescription/receipt printer driver 3900 allows manager module 3200 tooperate a prescription/receipt printer 3950 in a well-known manner.

Label printer driver 3925 allows dispenser module 3100 to operate alabel printer 3975 in a well-known manner.

Some options include a security alarm sensors 3760, a camera 3765 totake a patient's picture or picture of an I.D., and an electronic locksystem 3770. Camera 3765 can also be located within the remote dispenserto provide and internal view of the various mechanisms of the dispenser.Thus it can be used as a diagnostic tool to help maintain the dispenser.

One option includes a telephone 3980 on the dispenser to allow the userto speak with the central control and call center to discuss anyinsurance problems, for example. The telephone can also allow a remotepharmacist or other health care provider to ask or answer any questionsby the user.

Manager

The manager module 3200 comprises various other software modules tosupport the following activities at the remote dispenser 3000.

Dispensing of Products

In one example, a patient who has a valid prescription voucher from aphysician initiates the dispensing activity at visual monitor 3450. Thepatient inputs the voucher number, patient birth date (or othervalidation method), their selection of products (if any beyond thoseincluded in the prescription), and, if necessary, a check into checkreader 3825, cash into cash acceptor 3830, or a credit, debit, ATM, orsmart card number through use of card reader 3850. One optionincorporates a “Bluetooth” or infrared enabled system within thedispenser which is in communication with a payment server, thus allowinga user to pay using a cell phone, or other Bluetooth (or infrared)enabled device. Manager module 3200 communicates with central server2000 to authorize the entire transaction. Once authorized, managermodule 3200 communicates with dispenser module 3100 to generate thedispensed medications; and with prescription/receipt printer driver 3900to print appropriate information and receipts on prescription/receiptprinter 3950. The system can also print up advertising, coupons, patientinformation, or other marketing information. The patient receives drugspecific education advertising via a screen or printer while product isbeing received. The information can be tailored to be drug specificand/or patient specific. The patient can be asked if they would likeadditional information about their medication sent to them, such asreminders about refilling their prescriptions, or if they would like tobe in a drug compliance program, for example. In addition, a toll freepharmacist helpline is offered via the interface or over telephone 3980.The interface can also provide marketing or educational information orquestionnaires.

In other examples, which will be further discussed below, the patient(or patient's agent, such as a friend or family member) can insert aregular written prescription into the dispenser. The dispenser can imagethe prescription and transfer the image to a pharmacy services providerwho can control the dispenser to deliver the medication or supplies.

Restocking of Products

An HCF staff person, for example, initiates the restocking activity.This person would typically be a local person at the HCF at which remotedispenser 3000 is located who has the proper security authorization.Restocking involves removing magazines that are empty or that have beenselected for removal (e.g., expired or superceded products). Managermodule 3200 tracks restocking activity and communicates appropriate dataover server interface 3500 to central server 2000 so that properinventory control is maintained. After each restocking, or after eachtime the door is opened, the system goes through each position withinthe dispenser to verify and update the location of each item in thedispenser. This means that the restocking person does not have to worrythat they are putting the right product in the correct slots. Whereverthey put it, the system will rescan each slot and update the positioneach product. Moreover, since the medication comes pre-filled andpre-checked in the magazines (from prescription bottler 7000, forexample), the system provides a fool-proof, safe medication deliveryparadigm.

Diagnostics

A maintenance person initiates the diagnostic activity. This personwould typically be a dedicated maintenance person who travels from oneremote dispenser 3000 to the next. Diagnostics include testing theavailability and functionality of the hardware components of remotedispenser 3000. In addition to testing individual components, the entiredispensing activity can be tested by dispensing a placebo or otherproduct.

The maintenance and diagnostic routines are preferably implemented byputting an invisible button on the voucher number entry screen portionof visual monitor 3450. For example, after entering a special passwordcode for voucher number, and pressing the hidden button twice, themaintenance mode is entered if the special password code is otherwisevalid. A selection of available options, depending on authorizationlevel, is displayed: restocking of products, rescanning of productmagazines to verify inventory; display of current inventory (includingan option to print the result on prescription/receipt printer 3950);diagnostic routines; communication status (e.g., “pinging” other devicesto ensure that communications links are active); dispensing a placeboproduct to display the status of the dispensing operation by exercisingall devices including motors, scanners, and printers (the placeboproduct will be labeled to test label printer 3975); manual operation ofavailable hardware (e.g., activating various motors, displaying scannedinput from a test of input devices, and the like); confirmation ofconfiguration for devices that are configurable (e.g., communicationsport parameters, logical addresses of each device); and, status ofcommunications to central server 2000 (typically a multi-step routine inwhich first visual monitor 3450 displays the status of the connection tocentral server 2000, followed by an active pinging of central server2000, followed by pinging of any router that may be between serverinterface 3500 and central server 2000, etc.).

Advertising and/or Educational Information

Visual monitor 3450 may display information such as educationalinformation or advertisements during idle times and during certainstages of the dispensing activity. The educational information oradvertisements may be in the form of images, animation, audiovisualworks, etc. without limiting the scope of the invention.

Error Recovery

Manager module 3200 will attempt to recover from errors that areencountered during dispensing. Such errors include communicationproblems with the central server 2000, and hardware problems on theremote dispenser 3000. The central server 2000 will be appropriatelynotified of the errors.

Monitoring

Manager module 3200 notifies central server 2000 when appropriateboundary conditions are approached or exceeded. Such conditions includetemperature, interruption to normal line voltage power supply, papersupply for each printer 3950 and 3975, physical access to remotedispenser 3000, and failed dispensing caused by mechanical or electricalfailure, for example.

HCF System

Referring again to FIG. 1, each HCF system 4000 comprises a patientregistration client 4100, a HCF workstation 4200, one or more computers4300 (as an example only, FIG. 1 shows four such handheld computers4300, computers 4300 can also be desktop or laptop computers), and oneor more laser or thermal printers 4400. Registration client 4100 may beany suitably configured network capable personal computer or dedicatedterminal in communication with HCF workstation 4200. HCF workstation4200 may be any suitably configured network capable personal computer;the preferred configuration is a small form factor personal computerfrom Compaq, running Microsoft Windows NT Workstation 4.0. Computer(s)4300 may be any suitably configured desktop or portable computer such asa laptop, palmtop, personal digital assistant, etc. The preferred modelis a Palm Vx from Palm Computing, running Palm OS. Another example modelis a PC having a web-based application. Printer 4400 is connected to theHCF system 4000 in a well-known manner and may be any suitablyconfigured model of laser or thermal printer.

A software application for client registration runs on the HCFworkstation 4200, and is written in a language pertinent to thatplatform, preferably Java for display in an Internet browser applicationrunning on the patient registration client 4100. One option includes aninsurance card scanner 4120 to allow the HCF personnel to input an imageof the insurance card into the system.

A software application for prescription writing runs on both thehandheld computers 4300 and the HCF workstation 4200, and is written inlanguages pertinent to each platform. The software application processesthe creation of prescriptions and vouchers that may be used to obtainprescriptions from the remote dispenser 3000; printing of prescriptions,vouchers, and adjudication results; and modifications to prescriptionsand vouchers. The portion of the software that runs on the handheldcomputers 4300 is preferably an application for the Palm OS developedwith the CodeWarrior development platform, but this is not a limitationon the scope of the invention. The portion of the software that runs onthe HCF workstation 4200 is preferably a Java application for display inan Internet browser application running on the workstation 4200, butthis also is not a limitation on the scope of the invention.

Each HCF system 4000 is connected to the central server 2000 throughwell-known networking techniques, such as a frame relay cloud or avirtual private network (VPN) or both. Other networking techniquesinclude dial-up, ISDN, satellite uplink, etc.

Adjudication System

The adjudication system 5000 can communicate with third party payers9000 through a “switch” company such as Envoy or NDC. A commerciallyavailable application, provided by the third party payor, may be used inaccordance with well-known principles to exchange data between centralserver 2000 and adjudication system 5000.

Cash, Check, Credit, Debit, ATM, or Smart Card Authorization System

The card authorization system 6000 is under the control of a third-partycredit card transaction clearing house. As noted above, custom writtensoftware is used to exchange data between central server 2000 and creditcard authorization system 6000. Check authorization can be accomplishedas discussed above.

Mail Order and Prescription Bottler Systems

The mail order system 6999 and the prescription bottler system 7000 canbe under the control of a third-party distributor of products to beprovided to remote dispenser 3000. A commercially available application,provided by the distributor, may be used in accordance with well-knownprinciples to exchange data between central server 2000 and systems 6999and/or 7000. Systems 6999 and 7000 can be FDA-approved repackagingsystems to repackage unit doses from manufacturers into prescriptionsize packages.

Drug Formulary System

As described above, the preferred method for importing and maintainingdrug formulary files on the central server 2000 is to import andmaintain drug formulary data files 8000 provided in any convenientformat. Such files can be transferred and managed using any well-knowndata storage medium, or they may be transferred and managed using adirect network connection between central server 2000 and the publisherof the drug formulary data files.

Patient Visit and Prescription Process—Overview

FIG. 3 illustrates the basic process by which a patient is seen by aprescriber, receives a prescription, and has that prescription filled byremote dispenser 3000. In the patient registration process, the patientpresents himself or herself at a registration desk where patientregistration client 4100 is located. Patient information is captured bypatient registration client 4100 and transferred to HCF workstation4200, or if the system omits workstation 4200, the information can betransferred directly to central server 2000 (See FIG. 1). If the patienthas insurance, the insurance card can be scanned with scanner 4120. Inthe examination process, a prescriber (typically a physician) examinesthe patient and, depending on the outcome of the examination, may desireto prescribe a product for the patient. In the prescription writingprocess, the prescriber uses the computer 4300 to write a prescriptionby entering the prescription data into the handheld computer 4300 andtransferring the data to the HCF workstation 4200. In one embodiment,the prescriber can bypass the handheld computer and directly enter theinformation into workstation 4200. Some embodiments of the presentsystem omit computer 4300 and allow the prescriber to simply write outthe prescription on a typical prescription pad, as will be discussedbelow. In another example, the prescriber can call the prescription into the call center 9050. In another example the prescriber may havetheir own prescription entry system and they can enter it into thatsystem and then upload the data to the central server.

In the adjudication process (if the patient has insurance), datarepresenting the prescription and associated insurance information ofthe patient is sent by the HCF workstation 4200 to the central server2000 for processing and subsequent transmission to the adjudicationsystem 5000 under the control of a “switch” company that routes theprescription information to the proper third party payer. Theadjudication system 5000 transmits data regarding the outcome of theadjudication to the central server 2000, which processes it accordinglyand notifies the HCF system 4000 of the outcome. If necessary, the HCFstaff can resolve any outstanding issues and retrieves the adjudicatedprescription and/or voucher from printer 4400 of HCF system 4000. In oneembodiment, rejections can be routed to call center 9050. The callcenter 9050 analyzes the rejection and views scanned insurance cardimages. After any corrections are made, the claim is resubmitted or theprescription is printed for the patient.

In the discharge process, the HCF staff transfers the prescription orvoucher to the patient as part of terminating the examination process.In the prescription retrieval step, the patient uses a check, cash, avoucher or their card at the remote dispenser 3000 to have theirprescription filled. This process involves the remote dispenser 3000communicating with the central server 2000 for verification, inventorycontrol, and other purposes. The remote dispenser 3000 can also beconnected to call center 9050 to allow for any questions or problems tobe resolved.

Patient Registration Process

FIG. 4 illustrates the patient registration process in more detail. Thepatient provides basic information to the registration clerk or theinformation is retrieved from a patient database. Such data wouldtypically include mandatory information (name, gender, date of birth,mailing address, and telephone number) and optional information (socialsecurity number; weight; known allergies; prescriber name; prescriptionbenefit insurance company name, policy number, group number, membernumber, and relationship code). Either the patient registration client4100 contains an automatic interface to an existing registration system,or an application that captures the necessary information for the firsttime, or the information is manually entered into the system or theinformation is faxed or scanned to a remote location for manual entry,or some combination of the above. In either case, the captured data isimmediately transferred to HCF workstation 4200, central server 2000,and subsequently to the specific computer 4300 (handheld or desktop) inuse by the specific prescriber assigned to the patient. Also, at thistime, the patient's insurance card can be scanned into the system.

Prescription Writing Process

FIGS. 5A and 5B illustrate the prescription writing process in moredetail. The prelude to the specific process of writing a specificprescription is for a prescriber to obtain a handheld computer 4300 (orother computer or any suitable electronic data entry device) suitablyconfigured for the patient that is about to be examined by theprescriber. The prescriber confirms whether the computer 4300 isproperly configured with information pertinent to the HCF in which it islocated, a process that could occur once each day when the prescriberfirst arrives at the HCF. If not, a well-known synchronization (or, morecommonly, a “sync”) of the computer 4300 to the HCF workstation 4200 ordirectly to the central database server will configure the computer4300. A similar process is required for confirmation whether thecomputer 4300 is configured with information pertinent to the currentprescriber, a process that could occur if prescriber uses a computer4300 that is resident at that particular HCF and shared between multipleprescribers. Once the HCF and prescriber are both properly configured inthe computer 4300, the prescriber performs a password-based loginprocess. The sync may occur via infrared frequency or may occurautomatically via a number of wireless technologies.

The prescriber examines the patient and decides whether to prescribe aproduct. If so, the prescription writing module is activated. First itmust be confirmed whether the computer 4300 is configured withinformation pertinent to the current patient. If not, a sync process isperformed to retrieve the pertinent data from the HCF workstation 4200or central database server. The prescriber can then choose from a “mypatient” list of patients or an “all patients” list of patients. Oncethe computer 4300 is ready to receive a prescription for the currentpatient, the patient's weight is entered (if in pediatric dosage mode).The user can then choose between a list of “my medications” and “allmedications.” The drug lists show or flag for the prescriber which ofthe drugs are presently in the automatic drug dispenser. A drug ischosen, and strength and dosage of the drug are chosen. One exampledetermines if the patient has any allergies to the medication.

Since the patient's insurance plan can be uploaded to the computer alongwith other patient information, each drug viewed will usually indicatewhether the drug is on the patient's insurer's formulary along with itsapproval status and whether the drug is in the remote dispenser. If thedrug is not on the patient's insurer's formulary, the prescriber may beprompted to a drug of the same therapeutic class that is covered on thepatient's insurer's formulary.

A default entire prescription for the chosen drug will then appear onthe computer 4300. The prescriber can accept the defaults or chooseothers from a list, or write in their own. The prescriber may select awell-known SIG code for the product if one is available, otherwise onemay be written by the prescriber. Similarly, if a standard quantity isavailable, it may be chosen, otherwise the prescriber may choose aquantity. The number of refills permitted without the patient requiringa new prescription is chosen, and the prescriber indicates whether theprescription is to be “dispensed as written,” i.e., an equivalentgeneric drug can not be substituted in place of the specific brand ofdrug for which the prescriber has written. The prescription may undergoa drug utilization review (DUR). This includes drug-drug interaction,dosage range checking, patient allergy checking, pregnancy and lactationalerts and other safety checks. This entire process is repeated for theeach product prescribed.

As noted above, the prescription writing system includes a “pediatric”dosage calculation mode when writing a prescription for a child, forexample, or at any time dosage is critical. In that case, the user hasthe option, before selecting the drug name, to toggle the system intopediatric dosage mode. The prescriber will then be prompted to enter thepatient's weight. After that, the daily dose is selected. As theprescriber adjusts the daily dosage, the system automatically calculatesthe exact dosage (in units per day). The prescriber then chooses theform and strength of the drug (if the prescriber selects a dose thatexceeds the maximum recommended dose/m/k/day, they will be prompted toanswer a question confirming their interest in selecting that dose. Theprescriber then chooses the prescription instructions. Further detailsof this process are shown in FIGS. 28F-29C.

It is not necessary to limit the availability of products to only theremote dispenser 3000 located at that particular HCF. The computer 4300is able to indicate current inventory status of all remote dispensers3000 because the sync process has given it extremely timely inventoryinformation from the central server 2000 by way of the HCF workstation4200. The prescriber may then determine from the patient whether thepatient desires any of the products available from any of the remotedispenser(s) 3000 convenient to the patient's current location, or home,or other eventual destination. If so, the prescriber notes this on thecomputer 4300 so that a voucher may be generated. If not, the patient isgiven the option of receiving a printed traditional prescription thatmay be taken to a pharmacy of the patient's choice, or if the patientidentifies a particular pharmacy to receive it, the prescription may betransmitted directly to that pharmacy by facsimile, e-mail, or othercommunications channels. In another example use of the present system,the prescriber gives a voucher to the patient and the patient takes thevoucher to the dispenser. The patient can then make the decision at thedispenser whether to receive the product from the dispenser or to get aprinted copy of the prescription.

Regardless of the choice, a final synchronization of the computer 4300to the HCF workstation 4200 or central database server transfers thedata to the HCF workstation 4200, the central system 2000, and theremote dispenser 3000 as appropriate. It is preferred but not requiredthat this final synchronization also include updating the computer 4300with not only the current inventory levels of the remote dispenser 3000in the local HCF, but also the information pertinent to the nextpatients registered or scheduled to be seen by prescribers at the HCF.

Patient Discharge Process

FIG. 6 illustrates the patient discharge process in more detail. The HCFstaff receives information on the prescription or voucher from theprinter 4100. In one embodiment, the staff determines if there are anyoutstanding issues remaining from the adjudication process. If so, itmay be possible to modify the transaction to permit re-adjudication, orif not the transaction is modified into a traditional prescription thatcannot be filled by any of the remote dispensers or communicated to apharmacy of the patient's choice via facsimile, e-mail or other forms ofcommunication. Alternatively, as noted above, the call center 9050(FIG. 1) will handle any adjudication issues. Either the traditionalprescription or the adjudicated prescription (in the form of a voucherprinted at printer 4100 and redeemable at the remote dispenser 3000) istaken to the examination room and presented to the patient after anyoutstanding questions from the patient are answered. Or, if the HCFprefers, the patient may receive either document upon leaving the HCF.Alternatively, as noted above, the patient may receive the prescriptionfrom the printer on the dispenser.

Prescription Modification Process

FIG. 7 illustrates the process of modifying an established prescription.To void an established prescription entirely, the entry is retrievedfrom the HCF system, a “void” option is recorded, and all paperdocumentation of the prescription is manually discarded. Additions orchanges to an existing prescription are also entered on the HCF system.

Stock Ordering Process

FIG. 8 illustrates the process of ordering stock (either product such asprescription drugs, or over-the-counter drugs, or supplies such aslabels and printer paper) for each remote dispenser 3000. Because allinventory data is maintained on the central server 2000, this process isexecuted there. In accordance with well-known inventory controlprinciples, reorder points (quantities and/or dates to triggerreordering) are maintained for every stock item. When the actualinventory levels identify those stock items that are at or below theirreorder points, orders for such items are generated and transmitted toappropriate fulfillment vendors. The central server provides orders foreach HCF in addition to an aggregate order to the fulfillment vendor(which for example, may be the HCF's own pharmacy, a repackager, abottler, a mail-order system, etc.). The fulfillment vendor processesthe order and ships the new stock to each individual HCF, even if theorders of each HCF have been aggregated together into a common ordersent by the central server 2000. Personnel at each HCF or centralpersonnel are responsible for restocking each remote dispenser 3000, andfor returning any replaced or overstocked items, both as described inmore detail below. Each remote dispenser 3000 automatically transmitsupdated inventory data to the central system 2000 where a reconciliationprocess identifies whether there are any discrepancies betweenanticipated and actual amounts and locations of each item. If there arediscrepancies, they are identified and the HCF or vendor or both arenotified so that all discrepancies may be resolved.

Restocking Process

FIG. 9 illustrates in more detail the process of restocking each remotedispenser 3000. When new items arrive at the HCF, the remote dispenser3000 is put into restocking mode, which is preferably accomplished byentering a specific security code, which if valid, activates the managermodule to contact the central system for the most recent data relevantto the restocking process. Once the security code is validated and thedata is received, the portion of the remote dispenser 3000 dedicated toproduct inventory is unlocked and available for access. The first maintask is to remove magazines that have been identified by the manager asempty of product, discarding the empty magazines themselves. Next,magazines that have been identified by the remote dispenser 3000 ascontaining products to be returned are removed. The individual productsare removed from the magazines and returned, while the emptied magazinesare discarded or returned. Then, magazines containing new supplies areinstalled as required.

Once the portion of the remote dispenser 3000 containing the products isclosed and locked, the manager module 3200 scans all magazines toconfirm whether all empty magazines and all magazines containingproducts to be returned have been removed, and it checks that all newmagazines have been properly inserted. If not, the restocking process isnot complete and must be re-performed. If so, data representing thecurrent inventory levels and the inventory transactions that have justoccurred is transmitted to the central server. Once this is complete,the visual display 3450 confirms completion of a successful restockingprocess. As noted above, the system rescans each slot after the producthas been loaded and performs an update of the position of each product.This provides a fool-proof, safe system since a given product can beplaced anywhere within the dispenser and the rescanning process willautomatically update the product's position, thus not relying on anyhuman interaction. Moreover, the FDA-approved bottler or repackagerprovides a trusted product.

Prescription Dispensing Process—Overview

FIG. 10 illustrates the basic process by which a patient has aprescription filled by remote dispenser 3000. In the patient dischargeprocess, the patient either received a voucher for a product located inthe remote dispenser 3000, or they may exchange a traditionalprescription for such a voucher (or vice versa). Once in possession of avoucher, the patient begins by selecting a language in which theremainder of the exchange with the remote dispenser 3000 will takeplace. Then the patient enters the unique voucher number printed on thevoucher along with patient authorization data (such as birth day andbirth month, but this is only an example). In one option, the voucherincludes a bar code having all the necessary information and that can bescanned by the dispenser. The manager module 3200 determines whether thevoucher number is valid and if so whether it properly correlates withthe authorization data that the patient has entered. If not, the entryprocess is repeated in case erroneous data has been entered throughsimple human error. At this or at any other point in the process priorto acceptance of the entire voucher-based transaction, there is anoption to cancel the voucher-based transaction and print a traditionalprescription on printer 3950 for the patient. A further option, asdiscussed above, is to provide a camera to take a picture of the patientor a picture of an I.D, or other security measure such as a retinalscan.

Once a valid voucher and set of authorization data have been entered,the visual display 3450 shows a summary of existing prescriptions to befilled and a selection of possible over-the-counter (OTC) products thatmay be dispensed from remote dispenser 3000 without a prescription. Thepatient selects which if any products they wish to receive from remotedispenser 3000. The patient purchases their selections by passing acredit card through credit card reader 3850, or depositing cash, orusing the check reader, or using a cell phone IR feed, or any othercash, check, debit, or electronic payment method. Manager module 3200receives data from the credit card (or check, etc.) through credit cardreader driver 3800 and transmits it to central server 2000 so that thetransaction may be conducted with credit card server 6000 (or checkserver, etc.) in a well-known manner. As is common in the art, this mayinvolve a repeated entry of credit card data by the patient for avariety of well-known reasons. Once the payment transaction isauthorized, manager module 3200 directs dispenser module 3100 todispense the proper products. Manager module 3200 then prints a receiptand patient information, drug education information, ads, coupons, ormarketing information on printer 3950 for the patient to take with themalong with their products. Manager module 3200 then sends updatedinventory and transaction data to central system 2000. As noted above,during the process, the phone on the dispenser can be used to talk tosomeone at the central control or to a pharmacist. Moreover, after theprescription has been filled and if there are refills on theprescription, a menu on the screen can be provided to allow the patientto have the refills transferred to a pharmacy of their choice.

Remote Dispenser

As shown in FIG. 11 and FIG. 12, the remote dispenser 3000 consists of acontrol module 102 and a cabinet module 104. Optionally, the controlmodule and cabinet module may be housed in a single cabinet. The basicconfiguration includes one control module and one cabinet module.Alternatively, an additional cabinet module may be added for increaseddrug storage capacity.

The control module 102 houses subsystems that provide the interfacebetween the remote dispenser 3000 and the medical patient. Thesecomponents include a 17 inch Monitor with touch screen 202, a creditcard reader 204, a prescriptions/instructions/receipts printer 206, aprescription/instructions/receipt output slot 208, an internal wasteslot/waste basket 210, speakers 212, and a controller PC 214.

An example of hardware and software that are suitable for the controllerPC 214, which is located in the control module, is a Dell OptiPlex GX110Mini-Tower having the following specifications: GX110 Pentium IIIprocessor, 500 MHz, 512 half speed cache & Integrated NIC; Memory: 128MB Non-ECC SDRAM (1D IMM); Keyboard: Quietkey (Space saver); VideoSolution: Integrated Intel 3D graphics with Direct AGP and 4 MB DisplayCache; Hard Drive: 10 GB EIDE (7200 RPM); Floppy Drive: 1.44 MB 3.5″; 4(Min) PCI/ISA Slots; 2 (Min) serial ports; Dimension: Tower with Maxsize: 18∝ H×17″ L×8″ W; Extra Parallel Port Card; Sound Card: SoundBlaster Audio PCI (64 Voice), use with CD, DVD or CD-RW; CDROM; NetworkCard: Integrated 3Com EtherliNk 10/100 with ACPI and Remote Wake-upOnly; and Operating System: Windows NT 4.0 Workstation SP5 with CD usingNTFS. Other generally equivalently performing hardware and softwarecould be substituted in a known manner without limiting the scope of theinvention. In accordance with known principles, the design of the systemshould be such that the system functions are not dependent upon theparticular hardware or software selected for implementation, thuspermitting the system to migrate to other hardware or software platformswithout any change in the scope of the invention.

The credit card reader/acceptor 204 is preferably from IDTech Company.Other generally equivalently performing hardware and software could besubstituted in a known manner without limiting the scope of theinvention.

The prescription/instruction/receipt printer is preferably a DatamaxOvation 2!, Direct Thermal Printer, and is located in the controlmodule. The printer uses the same paper to print prescriptions,instructions and receipts on 4″×5″ sheets. The patient informationsheets are automatically trimmed to the proper length. The printer alsoprints product return packing slips and miscellaneous inventorytransaction reports.

The remote dispenser 3000 is equipped with a temperature sensingsubsystem (not shown) having both over temperature and under temperatureset points. The central server is alerted if the temperature exceeds theset points.

FIG. 12B shows an automatic dispenser 3000B according to one embodiment.Dispenser 3000B includes many of the features discussed above fordispenser 3000 and certain details will be omitted for sake of clarity.Dispenser 3000B includes a flat screen monitor 202B located on the frontdoor 290 of the dispenser 3000B. In this example, front door 290 swingsopen to expose the product cabinet module located behind the door.Dispenser 3000B also includes a telephone 288, an electronic lock 280, aprescription receptacle 282, a credit/debit card reader 204, a checkreader 284, a cash deposit 286, and a change return 292.

As shown in FIG. 13, prescription drug products are stored in thecabinet module 104 in pre-filled magazines 106 that rest on shelves andsurround cantilevered lead screws 130. The products are delivered toremote dispenser 3000 in the pre-filled magazines 106 and dispensed fromthe magazines. A cabinet 108 encloses the cabinet module 102. Thecabinet module stores product prior to dispensing and has a hinged door.The cabinet module also encloses the gantry transport system 110,product rotator 118, label printing system 122, and an uninterruptiblepower supply (UPS) (not shown). The UPS allows the remote dispenser tocontinue to function, in the event of power loss, long enough tocomplete any vending operation currently in progress and to achieveproper shutdown of the computer system.

The cabinet encloses a gantry system 110 that is used to position an endeffector 112 and a magazine scanner 114, preferably a single directionalscanner from PSC Company, model # LM520 single line laser scanner.Optionally, the remote dispenser may utilize a handheld scanner. Thehand held scanner is stored inside the remote dispenser and may be usedduring restocking product.

The end effector 112 includes a product catcher 116 that transports theproduct from the magazines to a product rotator 118. The product rotatorrotates the product for bar code reading by the bar code readers 120,121 and application of the label by the label printer 122.

Bar code reader 120 is preferably an Omni directional scanner from PSCCompany, model # VS800 Omni-directional laser scanner. TheOmni-directional scanner 120 is located in the cabinet module and scansbarcodes on the sides or bottom of product. Bar code reader 121 ispreferably a single directional scanner from PSC Company, model # LM520,single line laser scanner. Bar code reader 121 is used to scan the sideof product while in the product spinner.

The label printer 122 is preferably a Datamax Ovation 2! having athermal transfer ribbon attachment. Optionally, the printer may use adirect thermal technique. The label printer prints 2″×4″ prescriptioncontainer labels with bar codes and is compatible with the labelapplicator.

After the product is labeled, the product is dispensed through theproduct chute 124 by activating the chute door motor 126 or if theproduct is rejected it is sent to the reject bin 128. The product chuteallows the labelled drug to be delivered to the patient at the remotedispenser, while preventing any individual from reaching into the chuteto the point of being injured. Additionally, the control module is in alocation proximate to the product chute where the product is dispensedto the patient.

The reject bin is a receptacle which stores products that do not passthe bar scan checks. The packages are later removed and returned to thevendor.

FIG. 14 shows an exploded perspective view of the magazine and leadscrew system 129. The cantilevered lead screws 130 are mounted to theinside back panel 132 of the cabinet module 104. In one example, themagazine 106 is mounted on the lead screw 130. Alternatively, a shelf isprovided for the magazine to rest on. The magazine cartridge consists ofa cardboard outer shell 132 and a vacuum molded inner portion 134. Theproduct 136 is stored within the magazine 106. A pusher 138 for movingthe product is threaded on the lead screw. The lead screw and pusher aremechanical elements designed to support the magazine within the cabinetmodule and to dispense product from the magazine. The lead screw is athreaded rod which, when rotated, causes the pusher to advance. Thepusher is used to advance the product within the magazine assemblyduring the dispensing process. The magazine itself contains the productfor a given magazine position (one specific product for a givenposition).

The magazine is a container that serves the dual purpose of a shippingcarton and product-dispensing magazine. The magazine can include threeprinciple components: a corrugated (cardboard) paper outer shell 132, avacuum-molded plastic inner liner portion 134, and a bar code label 135placed on the outboard end of the magazine. The outer shell is a tubedesigned to support the inner portion during shipping and handling andduring application inside the remote dispenser. The inner liner portionis designed to prevent the product from changing orientation duringshipping and handling, as well as to align the magazine to the leadscrew and to guide the products during the dispensing process. The barcode label is used to identify the contents of the specific magazine sothat the appropriate preprogrammed dispensing procedure is affected. Ifthe magazine rests on a shelf, the liner 134 can be omitted. Theexterior surface of the magazine may also contain a legible labelstating the drug product content of that magazine. However, the barcodelabel 135 on the outside of the magazine may have the drug product nameprinted in English (or other language) in addition to the barcode or theproduct package is readable within the magazine.

FIG. 15 is a front view of the gantry transport system 110. The gantrytransport system 110 is a two-dimension robotic assembly used toposition the end effector 112 at a given magazine position.Additionally, the gantry system transports the product from the magazineto the product rotator and label printer and also positions the magazinescanner 114.

The gantry transport system 110 includes an x-axis system 142 and any-axis system 144. The x-axis system moves the y-axis system and the endeffector 112 from side to side, while the y-axis system moves the endeffector 112 up and down. The x-axis system includes an x-axisbelt/cable 146, x-axis pulleys 148, and an x-axis motor system 150. Thex-axis system consists of a belt 146 looped around pulleys 148 and acable 146 looped around idler pulleys 148. The motor system 150 consistsof a motor, gearbox power supply and controller. As the controllersignals the stepper motor, the motor repositions the belts and cablesand moves the y-axis system from side to side.

As shown in FIG. 16, the y-axis system consists of an y-axis belt/cable152, y-axis pulleys 154, and an y-axis motor system 156.

FIG. 17 is a cross sectional view of the y-axis transport system. They-axis system is supported on a frame structure 158. The frame structureconsists of a Lexan rail 160 affixed to an aluminum tube 162. Guidewheels 164 aligned the y-axis system along rail 160.

FIG. 18 is a perspective view of end effector 112. The end effector is amechanical device mounted on the gantry transport system and is used toretrieve and transport the product during the dispensing process. Theend effector 112 includes the magazine bar-code scanner 114, a drivescrew motor 166, a lead screw coupler motor 168, an optical sensor 170,a mounting plate 172, and a product catcher 174. The lead screw couplermotor 168 advances a drive adapter (not shown) to couple to the leadscrew. Optical sensor 170, upon detecting the “fall” of a product intothe product catcher, signals the lead screw drive motor to stopadvancing the product out of the magazine tube. The product catchercaptures the product as it is advanced out of the magazine. The productcatcher includes a stationary mitt 180, and outside moveable mitts 176,178. In some examples, the drive screw is omitted and each of the leadscrews 130 is driven by a separate motor associated with each lead screwand controlled by the dispenser's controller.

FIG. 19 shows a side view of product rotator 118. The product rotatorserves the function of spinning the product in the barcode scanner beam,so that the product can be identified, and rotating the product as theproduct label is applied. The product rotator 118 consists of tworotating disks 182, one of which is mounted to a traveling arm 184 thatis actuated by a screw 186 that is driven by motor 188. When the packageis transferred to the product rotator, the traveling arm 184 is movedinward, the disks are brought together, and the package is capturedbetween the disks. A second motor 190 then acts via a second screw toposition the entire rotator mechanism under the label printer. A thirdmotor 192 spins the disks and rotates the package to effect labelapplication. The traveling arm 184 moves along rails 194 on guide wheels196.

FIG. 20, shows an end view of the product rotator 118 showing thepositioning of motors 188, 190, and 192 and the positioning of rails 194and guide wheels 196.

FIG. 21 shows a perspective view of label printer 122. The printermechanism 197 generates an adhesive-backed package label 198 andadvances the label toward a transfer wheel 199. The label 198 is held onthe surface of the transfer wheel 199 by vacuum (adhesive side of labelis outward) while the drive motor (not shown) advances the transferwheel. A solenoid 195 retracts and allows the transfer wheel to swing tothe product rotator 118 for label application. The label makes contactwith the product package while the product rotator spins the package atwhich point the label adheres to and is transferred to the package. Asthe product spins, wheel 199 is supported by the product itself. Assuch, the wheel can accommodate almost any shape of box, bottle, orother item that needs labeling. In various embodiment, other types oflabelers can be used including, adhesive labelers, etc.

As shown in FIG. 13, one of bar-code scanners 120, 121 is used to scanthe pre-labeled product to verify that it is the right product. If not,the product is sent to reject bin 128 (FIGS. 13 and 22C). Also, afterthe product has been labeled by the labeling system 199, one of scanners120, 121 scans the label. Again, if it is mislabeled, the product issent to the reject bin. Accordingly, to dispense a prescription productfrom the present system, the system requires the product to go throughthree scans. First, the magazine is scanned to identify the magazineholding the product, then the product itself is scanned, finally thelabeled product is scanned. This triple check process is rigorous enoughto satisfy some current state laws for dispensing prescriptions.Moreover, it is anticipated that most states will allow use of thesystem once a state review board has reviewed the process. Accordingly,the present system provides a safe system for the dispensing ofprescriptions without the intervention of a pharmacist, or any humanintervention at all.

FIGS. 22B-22C show a product transporting system according to oneembodiment. This embodiment includes some of the same features asdiscussed above for FIGS. 13-22 and some details are omitted for sake ofclarity.

FIG. 22B shows an end effector 112B and a product rotator 118B. In thisexample, end effector 112B includes a product catcher 174B that includesa V-shaped cross-section. A product that falls into catcher 174B isprevented from falling off of the catcher by a gate 175. Gate 175includes a first side 179 which is rotatably coupled to the end effector112B using a pivot bar 177. The main body portion of gate 175 covers theouter, open end of catcher 174B. A second end 183 of gate 175 ispositioned to abut wheel 182A of product rotator 1118B when the endeffector is brought into position proximate the product rotator 118B.For example, as the end effector 112B is translated towards productrotator 118B, wheel 182A lifts gate 175 until the end effector islocated such that wheels 182A and 182B are approximately aligned oneither end of the product which is lying on the bottom of V-shapedcatcher tray 174B. Then as described above, motor 188 drives screw 186to bring wheel 182A towards wheel 182B until the product is held betweenthe two wheels. In this embodiment, wheel 182A is smaller than in theprevious example. This allows the wheel to clear the catcher as ittravels over the catcher to grasp the product.

FIG. 22C shows a product delivery chute 302 according to one embodiment.Product delivery chute includes a product holding portion 304 and aproduct delivery portion 306. These two portions 304 and 306 areseparated by a movable member 308. Movable member 308 acts as the floorof holding portion 304. As products are labeled by the system, they aredropped into holding portion 304. After all the products for a patienthave been prepared, an actuating member 181 (See FIG. 22B) on endeffector 112B contacts and activates a mechanism 310 that opens movablemember 308, thus allowing the products to fall into product deliveryportion 306. Product delivery portion 306 is in open communication withthe reach-in slot 312, allowing the patient to pick up their products.This two-step delivery process keeps all the products in one place untilthey are presented to the patient. Thus, a patient won't grab the firstone out and forget to take the rest.

Product Dispensing Process

The dispensing process will not initiate until the patient (or HCFstaff, or other authorized user) has entered all required informationand the cash, check, credit card, and/or insurance payment (ifnecessary) has been verified for inputs required to allow drugs to bedispensed.

In one embodiment, referring generally to FIGS. 13-22, the sequence ofevents in dispensing a product is as follows:

1. The x- and y-axis gantry motors position the end effector in thecorrect magazine location. The lead screw positioner motor extends thecoupler on the end effector toward the mating coupler on the lead screw,until the two couplers are intermeshed but not in contact, whichprevents excessive loads from being transmitted to the cantilever leadscrew assembly. A load sensor (e.g. a spring and a proximity sensor) isused to apply a known tip load on the cantilever lead screw assembly.The x- and y-axis gantry motors are then powered down to eliminateadditional forces being exerted. The drive screw motor 166 then engagesthe coupler until the sensor detects the necessary load, after which they-motor is powered up and lifts the end effector a pre-calculated numberof steps to unload the lead screw bearing. In an alternative embodiment,each lead screw has a motor attached thereto and the system turns oneach motor as necessary to advance the pusher and dispel the product.2. The drive screw motor 166 rotates the spring-loaded conicalcoupler/lead screw, advancing the pusher to dispense the product intothe catcher of the end effector.3. An optical sensor, positioned to detect the product as it falls intothe catcher, signals the drive screw motor to stop advancing theproduct.4. The product is transported via the end effector to the productrotator, where telescoping catcher is compressed by the product rotator.At the same time the product is then grasped and held between tworubber-faced disks, one idler and one driver disk.5. The clamp pressure is controlled by preset position/calibration of aproximity sensor and compression spring displacement.6. The product rotator rotates the package until scanned to verify thatthe correct drug is being dispensed. If the scan is successful, theremote dispenser completes steps 7 through 10 below. If the scan is notsuccessful, the product is dropped into the reject bin and the processreturns to step 1. If the scan reveals that the correct drug is notbeing dispensed, the magazine location is recorded, the HCF is alerted,and the process returns to step 1 at another magazine location for thesame drug.7. The label printer generates an adhesive-backed package label andadvances the label toward the transfer wheel. On example provides alabeling system which attaches in part via static electricity.8. The label is held on the surface of the transfer wheel by vacuum(adhesive side of label is outward) while the drive motor advances thetransfer wheel. A solenoid retracts and allows the transfer wheel toswing to the product rotator for label application.9. The product rotator spins the package and the label on the roller islowered onto the product package at which point the label adheres to andis transferred to the package.10. The scanner checks the applied label to verify that the label wasapplied properly.11. A flapper moves to divert the labeled package into the dispensingchute.12. The rotator disks retract allowing the package to drop, and theproduct is directed to the package output portal of the remotedispenser.

In another embodiment, referring generally to FIGS. 13-22, and 22B-22C,the sequence of events in dispensing a product is as follows:

1. The x- and y-axis gantry motors position the end effector in thecorrect magazine location. The lead screw positioner motor extends thecoupler on the end effector toward the mating coupler on the lead screw,until the two couplers are intermeshed but not in contact, whichprevents excessive loads from being transmitted to the cantilever leadscrew assembly. A load sensor (e.g. a spring and a proximity sensor) isused to apply a known tip load on the cantilever lead screw assembly.The x- and y-axis gantry motors are then powered down to eliminateadditional forces being exerted. The drive screw motor 166 then engagesthe coupler until the sensor detects the necessary load, after which they-motor is powered up and lifts the end effector a pre-calculated numberof steps to unload the lead screw bearing.2. The drive screw motor 166 rotates the spring-loaded conicalcoupler/lead screw, advancing the pusher to dispense the product intothe catcher of the end effector.3. An optical sensor (or other sensor), positioned to detect the productas it falls into the catcher, signals the drive screw motor to stopadvancing the product.4. The product is transported via the end effector to the productrotator, where one wheel of the product rotator lifts the gate on thecatcher and then the product is grasped and held between tworubber-faced disks or wheels, one idler and one driver disk.5. The clamp pressure is controlled by preset position/calibration of aproximity sensor and compression spring displacement.6. The product rotator rotates the package until scanned to verify thatthe correct drug is being dispensed. If the scan is successful, theremote dispenser completes steps 7 through 10 below. If the scan is notsuccessful, the product is dropped into the reject bin 128 and theprocess returns to step 1. If the scan reveals that the correct drug isnot being dispensed, the magazine location is recorded, the HCF isalerted, and the process returns to step 1 at another magazine locationfor the same drug, if any. Otherwise a prescription is generated.7. The label printer generates an adhesive-backed package label andadvances the label toward the transfer wheel. (O.T.C. products and waterfor reconstitution do not need to be relabeled).8. The label is held on the surface of the transfer wheel by vacuum(adhesive side of label is outward) while the drive motor advances thetransfer wheel. A solenoid retracts and allows the transfer wheel toswing to the product rotator for label application.9. The product rotator spins the package and the label on the roller islowered onto the product package at which point the label adheres to andis transferred to the package.10. The scanner checks the applied label to verify that the label wasapplied properly.11. If the label is correct, the product rotator moves so that productis over the dispense chute.12. The rotator disks retract allowing the package to drop and theproduct is directed to the product holding area.13. When all products have been delivered to the product holding area,the gantry moves and causes the catcher to actuate the floor of theholding area to release products to the output portal or deliveryportion of the dispenser.

Stocking/Restocking Process

Upon sending a new shipment of drugs to the remote dispenser, theproduct supplier also sends an electronic file, referred to as theproduct file that contains data on the contents of the shipment.

Preparing the remote dispenser for restocking consists of one or more ofthe following steps: a) Inserting a security code and having the codevalidated by the central server, b) Opening the cabinet door after usingthe electronic lock, c) Scanning the shipper bar code located on theoutside of the shipping carton (or on the packing slip), d) Displayingthe descriptions and locations of magazines to be removed and returnedto the vendor including magazines that are empty or products to bereturned for various reasons, e) Removing all empty magazines, f)Removing magazines listed on the display and scanning the magazinebarcode, g) Indicating if the correct magazine was removed, h)Displaying the status of the magazines by color, i) Scanning the barcodeof each package from the return bin that is to be returned to the vendoras well as any packages that have fallen from the magazine to the bottomof the remote dispenser, or alternatively just returning the packagesunscanned, j) Keying barcodes for packages that will not scan properly,k) displaying all scanned and keyed return products, l) Placing returnproducts in a return shipping carton, m) printing a packing slip ofreturn items and placing the packing slip in the return shipping cartonfor shipping to the vendor or to the HCF pharmacy, and n) sending anelectronic soft copy of the packing slip to the central server.

The process of refilling the remote dispenser consists of one or more ofthe following steps: a) Displaying the magazines in the new shipment, b)Scanning the barcode on each magazine from the new shipment, the barcodeindicating the contents of the magazine, c) Displaying an indicationthat the magazine was received, d) returning unreadable or unlistedmagazines to the vendor, e) loading the new magazines into any refilllocation, f) guiding the new magazine onto the lead screw at the refilllocation, g) pushing the new magazine fully onto the lead screwassembly, h) closing the cabinet door, and i) automatically scanning thebarcodes at the front of each magazine to confirm placement andlocation.

FIG. 22 shows another embodiment of the present invention. A moveableprinter 500 moves on the gantry transport system 110 as discussed above.The printer 500, such as an inkjet printer, directly prints on thepackage 136 or directly prints on a label 510 that is attached to thepackage 136. The packages 136 are stored in magazines 132 as discussedabove. The package 136 is positioned at the end of the magazine to allowthe printer to print on the label 510 on the product. Once the printingis complete the product is dispensed to the patient.

PDA Prescription Entry Program

The PDA Prescription Entry System allows new prescription entry usingpersonal defaults, new prescription entries needing customization, newpediatric prescriptions, viewing, revising or deleting prescriptionsalready written, and revising a prescription when the insurance deniesthe prescription. The entry system is operated using the control buttonson the bottom edge of PDA 4300. As shown in FIGS. 23-30, PDA 4300includes a back button 4310, a tab button 4320, a scroll button 4330, anenter button 4350, and a cancel button 4340. Tab button 4320 is used totab between screens. Cancel button 4340 is used to cancel or go back onefield. Scroll button 4330 is a bi-directional button and is used toscroll up and down. Enter button 4350 is used to enter and to move tothe next field. A hotsync button on the PDA cradle is used to provide ahotsync between the PDA 4300 and another device.

FIGS. 23-30 show exemplary screens of one embodiment of the PDAPrescription Entry Program. Although shown on a PDA, in one or moreembodiments, the following system can also be incorporated into a laptopor desktop computer.

FIG. 23A shows an exemplary screen for new prescription entry. The userchooses whether to display all patients or just patients to be seen bythe user. The preference is stored for the next time a prescription iswritten. The user scrolls down using scroll button 4330 to the firstletter of the patient's last name and presses enter button 4350. Theuser optionally may tab to another screen while writing the prescriptionand return later to finish the prescription at the point where the userleft off. When the HCF name 4360 has a gray background, there areprescriptions to upload. When the rejected tab 4370 has a graybackground an insurance rejection has been received.

FIG. 23B shows an exemplary screen for choosing a patient for a newprescription. The user scrolls through a patient list using scrollbutton 4330 to select a patient name. At either the top or the bottom ofthe screen scrolling begins one screen at a time. At the first change ofdirection, scrolling begins one patient name at a time. A new patient'sname may be entered by pressing enter button 4340 on the dotted line.

If pediatrics mode is toggled on, the program defaults to pop up awindow to enter the weight if the weight is not shown. For example, atscreen 23D, the user can be given a choice between pediatricscalculation mode or regular mode. If regular mode is chosen the programgoes to screen 23E and a default prescription is shown. If pediatricsmode is chosen the program goes to screen 28E.

FIG. 25C shows an exemplary screen for picking a quantity for a newprescription. The user uses scroll button 4330 to scroll down to pick aquantity from the list of quantities. Optionally, the quantities arelisted in the order of those most commonly written. The list includes adesignation, such as a “D” after those quantities available in theremote dispenser. In one example, a “+” sign denotes that the product isin the dispenser and a “−” denotes that the product is usually in thedispenser, but is out of stock. Blank means the product was not ever inthe dispenser. The cursor automatically highlights the closest largerquantity available based on the dosage and length of time to take themedication entered by the user. Optionally, the user may highlight adifferent quantity or enter a new quantity by pressing the enter keywhen the dotted line is highlighted.

FIG. 25F shows a screen for choosing how to dispense the prescription.The user may choose between having a written prescription printed out atthe dispenser in the waiting room, a dispenser at a remote location, orhave the prescription drugs dispensed at the remote dispenser,automatically fax or e-mail the prescription to the patient's pharmacy,or completely cancel the prescription.

FIGS. 28F and so on show one embodiment of pediatrics calculations mode.As noted above, in this mode the prescriber will be prompted to enterthe patient's weight. After that, the daily dose is selected. As theprescriber adjusts the daily dosage, the system automatically calculatesthe exact dosage (in units per day). The prescriber then chooses theform and strength of the drug (if the prescriber selects a dose thatexceeds the maximum recommended dose/m/k/day, they will be prompted toanswer a question confirming their interest in selecting that dose. Theprescriber then chooses the prescription instructions.

All these examples shown allow a user to write a prescription withoutusing any writing input into the PDA (for example using the “Graffiti”text input function on a Palm PDA). The user can write a completeprescription just using the buttons on the bottom of the PDA to find andselect the proper values for various parameters. This allows quick andpainless prescription preparation. Also, the user does have the optionof “graffiti” writing in some values if they want to make a change.

Additional Embodiments

Referring now to FIG. 31 there is illustrated still another exampleembodiment of a method according to the present invention. In thisembodiment, a medical service provider 9002 prescribes a medication fora patient. Such prescription may be conveyed from the provider 9002 to apharmacy service provider 9006 either as written instructions on a paperslip 9004, called into the pharmacy service provider 9006 by theprovider 9002, or otherwise conveyed such as by facsimilie or using anelectronic medium like e-mail or other electronic transfer. Theprescription is thus presented to the pharmacy service provider 9006 inoral or written (paper or electronic) form. The pharmacy serviceprovider 9006 then enters data about the prescription into a data inputdevice 9008 that relays the data to a medication dispensing machine9010, for example, any one of the embodiments described with respect toFIGS. 1-30 hereinabove. The dispensing machine 9010 automaticallyprepares a medication 9012 by preparing a container 9014 holding themedication wherein the container is automatically labelled 9016 withinformation specific to the patient by the dispensing machine. Suchinformation typically includes the patient's name and the medicationdosing and schedule. Further according to this embodiment, thedispensing machine 9010 is located remotely from the location of theprescribing medical service provider 9002.

According to another example embodiment of this method, the medicationis automatically labelled by the dispensing machine 9010 at the timethat the patient picks up the medication. In particular, it is labelledafter the patient arrives at the location of the dispensing machine.According to another example embodiment, the medication is automaticallylabelled by the dispensing machine 9010 prior to the time the patientarrives at the location of the dispensing machine to pick up themedication. According to another embodiment, prior to or after arrivalat the site of the dispensing machine 9010 the patient is provided witha code (for example an alphanumeric code 4-10 digits long) and thepatient enters the code into an input device 9018 on the dispensingmachine to obtain the labelled container. In one example, this canhappen if a patient calls to request a refill by phone or over theInternet. As discussed above, the user has payment options such as usinga check reader, cash, credit, debit cards, insurance, etc. Also, in oneexample, if the machine is in a store, the user can pick up thedispensed product and pay at a cashier.

According to still another embodiment shown in FIG. 32, a control system9009 for the dispensing machine 9010 is networked with a pharmacymanagement software system 9020 over a network 9022, which may includein part a local area network and a wide area network such as theInternet or a virtual private network, or satellite link, for examplebut not by way of limitation.

According to another example embodiment as illustrated in FIG. 33, themedical service provider 9002 is located in an HCF or medical servicefacility 9024, and the dispensing machine is in a location 9026 that isnot co-located with the facility or at location 9024. The medicalservice facility may be, for instance but not by way of limitation, adoctor's office, medical HCF or hospital, and the location 9026 can be apharmacy located, for example, off-site in the neighborhood or facilitycomplex, or many miles away in a drive thru window or virtually anylocation.

According to still another example embodiment of the inventionillustrated in FIG. 34, there is provided a method for dispensingprescribed medications. In this embodiment, a prescribing medicalservice provider 9032 prescribes a medication for a patient 9034. Dataabout the prescription is entered into a data input device 9036 thatrelays the data to a medication dispensing machine 9038, for example,any one of the embodiments as described hereinabove in FIGS. 1-30. Inone example, the dispensing machine 9038 can automatically prepare themedication for the patient by labelling 9040 a container 9042 of themedication with patient-specific information 9044. Alternatively, thelabeling can take place after the patient enters the proper informationand payment (if any) into the dispenser. In this embodiment, thedispensing machine 9038 is located remotely from the location 9036 ofthe prescribing medical service provider 9032.

According to one alternate embodiment of the method of FIG. 35, theprescription is presented to the pharmacy service provider 9033 orallyover the telephone, in written form by presenting it on paper, or inwritten form by an electronic delivery mechanism. The pharmacy serviceprovider operates dispensing machine 9038 to enter the prescription.

According to another example embodiment of this method, the medicationis automatically labelled by the dispensing machine 9038 at the timethat the patient picks up the medication. In particular, it is labelledafter the patient arrives at the location of the dispensing machine9038. According to another example embodiment, the medication isautomatically labelled by the dispensing machine 9038 prior to the timethe patient arrives at the location of the dispensing machine to pick upthe medication. According to another embodiment, the patient is providedwith a code (for example an alphanumeric code 4-10 digits long) eitherprior to or at the time they arrive at the location of the dispensingmachine 9038 and the patients enters the code into an input device 9046on the dispensing machine to obtain the labelled container.

According to still another embodiment shown in FIG. 36, a control system9037 for the dispensing machine 9038 is networked with a pharmacymanagement software system 9048 over a network 9050, which may includein part a local area network and a wide area network such as theInternet or a virtual private network, or satellite link, for examplebut not by way of limitation.

In yet another alternate embodiment as shown in FIG. 37, the medicalservice provider 9032 is located in a medical service delivery facility9054, and the dispensing machine 9038 is in a pharmacy location 9056that is not co-located with the medical service delivery facility 9054.According to this embodiment the medical service facility is, forexample, but not limited to one of a doctor's office, medical HCF orhospital.

Still another example embodiment of a method according to the inventionis illustrated FIG. 38. In this embodiment a medical service provider9062 prescribes a medication for a patient 9064, and data about theprescription is entered into a control system 9066 for a medicationdispensing machine 9068. The dispensing machine 9068 automaticallyprepares the medication by preparing a medication container 9070 holdingthe prescription medication wherein the container is automaticallylabelled 9072 with patient-specific information by the dispensingmachine. Further according to this embodiment, the dispensing machine9068 located remotely from the location of the prescribing medicalservice provider.

According to another example embodiment of this method, the medicationis automatically labelled by the dispensing machine 9068 at the timethat the patient picks up the medication. In particular, it is labelledafter the patient arrives at the location of the dispensing machine.According to another example embodiment, the medication is automaticallylabelled by the dispensing machine 9068 prior to the time the patientarrives at the location of the dispensing machine to pick up themedication. According to another embodiment, the patient is providedwith a code (for example an alphanumeric code 4-10 digits long, or abar-code, or a written prescription, or a voucher) and the patiententers the code into an input device 9074 on the dispensing machine toobtain the labelled container.

According to still another embodiment shown in FIG. 39, a control system9066 for the dispensing machine 9068 is networked with a pharmacymanagement software system 9080 over a network 9082, which may includein part a local area network and a wide area network such as theInternet or a virtual private network, or a satellite link, for examplebut not by way of limitation.

According to another example embodiment as illustrated in FIG. 40, themedical service provider 9062 is located in a medical service deliveryfacility 9084, and the dispensing machine 9068 is in a pharmacy, orother remote location 9086 that is not co-located with the medicalservice delivery facility 9084. The medical service facility may be, forinstance but not by way of limitation, a doctor's office, medical HCF orhospital.

Yet still another embodiment of a method according to the presentinvention is illustrated in FIG. 41. In this embodiment, a medication isordered using an automated order entry system 9102 from a first location9104. An order code 9106 is obtained, for example by the patient or thepatient's representative (which may be a family member or othercare-giver). The order code 9106 is subsequently entered into akeyboard, keypad or other data entry mechanism 9108 (voice recognitionfor instance) in an automatic dispensing machine 9110 in a location 9112geographically remote from the first location 9104. The dispensingmachine 9110 automatically labels a container 9116 of the medication andpresents it for pick-up, for example, with patient-specific information9117. Dispensing machine 9110 may be, in one example embodiment, of thekind described above in FIGS. 1-30.

Still another example embodiment of a method according to the presentinvention is illustrated in FIG. 42. A written prescription, for examplewritten or printed on a paper slip 9122, is imaged by an imaging and/orcard reader device 9124 at a location 9126 and relayed (for example overa computer network or phone system) to a location 9128 remote from thelocation 9126 where the image is obtained. A pharmacy service provider9130 at the remote location 9128 reads the relayed prescription image ordata 9129 and enters the order into a control system 9132 for adispensing machine 9134. The dispensing machine labels a container 9136of the medication and presents it for pick-up.

In one embodiment, a regular prescription written on a prescription pad(or prepared using the system discussed above) can be prepared using thepresent system. For example, the imager can be located on the dispenser.The user puts the written prescription into the dispenser where it isimaged and the image is transferred to a pharmacy service providerlocated virtually anywhere. The pharmacy service provider may requirethe user to provide some ID. The pharmacy service provider then entersthe relevant information, which is then transferred to the dispenser.The patient can enter any payment (if necessary) and the product islabeled and delivered, as discussed above. The dispenser then keeps thewritten prescription.

According to yet another example embodiment, the reading or imagingdevice 9124 is used in addition for reading or imaging an insurance card9123 and the data from the card in an image or other electronic form isforwarded to a remote pharmacy service provider. According to yetanother example embodiment, the insurance card reader may be the same ora different device from the device used to obtain an image or data froma prescription. According to yet another embodiment, a magnetic strip orother type of card reader is used to read an insurance card.Furthermore, in another embodiment, a user presents a credit card to beread by device 9024, and the credit card data is relayed both to thepharmacy service provider and to a credit card clearinghouse forapproval of a payment for a medication to be dispensed by machine 9134.

Another example embodiment of the method according to the invention isillustrated in FIG. 43. In this embodiment, a prescription is obtainedin electronic form 9144 from a medical service provider 9142. Theelectronic prescription is presented to a pharmacy service provider 9142using an electronic delivery system 9144. A dispensing machine 9146prepares a container 9148 of the medication and presents it for pick-up,wherein the container is automatically labeled by the machine 9146 withpatient-specific information 9149.

Another example embodiment of the method of the invention is illustratedin FIG. 44. A pharmacy 9152 is stocked 9154 with a variety ofmedications in containers 9156. An automatic dispensing machine 9158 islocated at the pharmacy 9152. The pharmacy is staffed with pharmacyservice providers 9160 during some but not all hours of a day. At leastsome prescriptions are filled for pharmacy customers at least in part byhand during the hours the pharmacy is open. At least some prescriptionsare filled for pharmacy customers using the dispensing machine 9158during hours in which there are no pharmacy staff available to dispenseby hand. According to one alternate embodiment of the method, thepharmacy service providers 9160 retrieve labelled medication containers9162 from the dispenser for customers during the service providers areworking in the pharmacy, and after the pharmacy staff are no longerworking, the customers 9159 themselves retrieve prescribed medicationcontainers with the prescribed medications from the machine 9158.According to this embodiment, machine 9158 in one example embodimenttakes the form of a machine as described above in FIGS. 1-30.

Still yet another example embodiment of a method according to theinvention is illustrated in FIG. 45. In this embodiment, a dispensingmachine 9172 is located at a dispensing location 9174. A patient 9176presents a written prescription 9178 for a prescription medication atthe dispensing location 9174. Information from or about the prescriptionis relayed to a pharmacist 9180 located remotely 9182 from thedispensing location 9174 where the pharmacist does not have immediatephysical access to the dispensing location 9174. The pharmacist readsthe prescription, checks the user's ID if necessary, and remotelyoperates the dispensing machine 9172 to cause it to automatically labela container 9184 of the medication with information 9185 specific to thepatient. The patient 9176 obtains possession of the labeled medicationat the dispensing location 9174. In one embodiment, the patient takesthe medication from the machine.

According to yet another example embodiment of this system and method, areading and/or imaging device is used for reading or imaging a patientinsurance card or credit card and the data from the card in an image orother electronic form is forwarded to a remote pharmacy serviceprovider. According to yet another example embodiment, the insurancecard reader may be the same or a different device from the device usedto obtain an image or data from a prescription.

Referring now to FIG. 46, there is illustrated an alternate exampleembodiment of a medication dispensing system according to the presentinvention. The medication dispensing system 9200 includes a card readerand/or imaging device 9202 adapted to image or read a prescriptionpresented by a patient or the patient's representative. A data inputterminal 9204 receives information concerning the patient for whom theprescription is written. A medication labeling mechanism 9206 isresponsive to a control system 9208 and produces labelled medicationcontainers 9210 labeled with information 9212 specific to the patient.The control system 9208 receives instructions from an input terminal9214 located remotely from the dispensing system. According to oneexample embodiment, mechanism 9206 is constructed in accordance withillustrated example mechanisms set forth hereinabove, with respect toFIGS. 1-30.

According to still another example embodiment of the inventionillustrated in FIG. 47, there is provided a pharmacy configuration 9220.Configuration 9220 includes a store 9222 having an enclosed pharmacyfloor space 9224 that is secured against unauthorized entry. Thepharmacy floor space 9224 further includes a storage or stock area 9226for a medication stock 9228, wherein the medication stock includes avariety of medications. An automatic medication dispensing machine 9230,for example, designed in accordance with any other above-describeddispensing machine embodiment, is co-located with the pharmacy floorspace and is accessible to pharmacy customers at least a portion of theoperating hours of the store. The machine 9230 is adapted to dispenselabelled containers 9232 of medications, wherein the label includespatient-specific information 9233. One or more pharmacy serviceproviders 9238 work in the enclosed floor space 9224 during some but notall hours of a day.

According to an example embodiment of this configuration, the machine9230 is positioned next to a configurable wall, gate, window or otherstructure 9240 that is an adapted so that pharmacy service providers canretrieve labelled medications from the dispenser for customers duringthe period of time the pharmacy is staffed, and so that when thepharmacy is not staffed the customers can retrieve prescribedmedications directly from the machine 9230 without assistance fromon-site pharmacy personnel.

According to still another example embodiment of this configuration, aremote counseling area 9242 with a telephone or other means ofelectronic communication such as e-mail or a chat room or a video link,is provided so that pharmacy customers may receive after hourscounseling from a pharmacist in a remote location using the telephone orother means. According to still another embodiment, a systemself-service station 9246 having a keyboard or keypad, for example, aprinting device and an imaging and/or reading device is positionedoutside the pharmacy floor space to allow a customer to submit aprescription or insurance card to a remote pharmacist as for exampledescribed with respect to FIG. 45, and also to enter a medication accesscode that may be printed for the customer and which causes thedispensing machine to dispense an appropriate medication for thepatient.

According to still yet another example embodiment of the methods,systems and configurations illustrated in FIGS. 30-47, the dispensingmachine is one of the designs described above with respect to FIGS.1-47, and furthermore is adapted to hold approximately up to 1000different medication options allowing a wide range of medicationprescriptions to be filled using the machine. According still further tothis example, any stock in any pharmacy floor space may have a greatervariety of medication options, so that a wider variety of medicationprescriptions can be filled from the floor stock than from thedispensing machine.

According to yet another example embodiment, the dispensing machineimplemented for the systems, methods and configurations of FIGS. 30-47include a mechanism for obtaining payment from a customer, as describedabove, for example by credit card, “blue tooth” payment technology,smart card cash card, cash bill changer, check reader, or any othermechanism to obtain payment from a patient. Alternatively, payment formedications may be received by pharmacy personnel or by other storepersonnel. Furthermore, the patient may use a card scanner or digitalcamera for I.D. (such as a driver's license).

Yet still another example embodiment of a dispenser of the invention isshown in schematic form in FIG. 48. This embodiment is useful, forexample but not by way of limitation, with some or all of the systems,methods and configurations described with respect to FIGS. 30-47.Dispenser 9250 includes both a mechanism 9252 for labelling medicationsper the description provided with respect to FIGS. 1-30, but furtherincludes an internal mechanical storage mechanism 9254, for example, aplurality of bins each holding one or more labeled medication containerand having a dispensing mechanism, allowing labeled medicationcontainers to be stored temporarily until such time as a patient orpatient's representative enters an access code to retrieve themedication. According to this embodiment, prescriptions may be filledprior to the patient coming to the dispensing machine, so that thelabelling is done in advance and therefore the pick up of the medicationfrom the machine takes less time as the only mechanical functioninvolves picking or selecting the pre-labelled medication for dispensingto the patient. Such storage mechanism, in one example embodiment, is aplurality of bins that the pre-labelled medications can be deposited inafter they are labelled, with a picker or other dispensing mechanismsuch as a solenoid controlled container ejector device or screwmechanism for retrieving or dispensing the pre-labeled medications fromthe bins under computer control. The bar codes of the pre-labelledmedications would again be checked prior to dispensing for qualityassurance purposes.

FIG. 49 illustrates a dispensing system 9300 according to oneembodiment. System 9300 includes a dispensing machine 9301, for exampleany of the dispensing machines discussed herein. System 9300 alsoincludes a feed mechanism 9304, such as a pneumatic tube device, ascommonly known. In this embodiment, machine 9301 is in a first location9302, which is inaccessible during some hours, for example a pharmacy,clinic, bank, etc. At a second location 9306, a user interface 9308 anda delivery point 9310 are provided. User interface 9308 can include aninput device such as a touch-screen or keyboard. It can also include atelephone, two-way video, and other options discussed above for varioususer interfaces for dispensing machines. It can also include featuresfor allowing payment, such as cash deposit, credit card readers, checkreaders, or an ATM interface, for example.

Feed mechanism 9304 connects dispensing machine 9301 to delivery point9310 where the user can obtain possession of the product disposed frommachine 9301.

In one example use, a user will enter their user information (such asvoucher number or other authorization code) and financial information(if necessary) at user interface 9308. The dispenser will act asdescribed above, preparing and labeling the product, then a robotic armor other means will deliver the product to feed mechanism 9304 where itwill be delivered to the user at delivery point 9310. In other exampleuses, a person can be inside location 9302 to facilitate thetransaction. Other examples provide a remote pharmacist to facilitatethe transaction from the remote location. For example, the pharmacistcan talk to the patient via a telephone or two-way video and thepharmacist can control the machine 9301 and/or the feed mechanism 9304remotely. In another example, a pharmacist located in location 9302 canreceive a prescription from a patient via feed mechanism 9304, fill theprescription, and deliver the product to the patient via the feedmechanism.

One or more of the ideas discussed above are usable on virtually anydispensing machine. For example, the check reader can be utilized on agas pump, or any vending or dispensing machine that is connected to acheck authorization system.

CONCLUSION

The embodiments described above are intended only to illustrate andteach one or more ways of practicing or implementing the presentinvention, not to restrict its breadth or scope. The actual scope of theinvention, which embraces all ways of practicing or implementing theteachings of the invention, is defined only by the following claims andtheir equivalents.

1. A system comprising: a dispensing machine having a plurality oflocations for holding a plurality of different medications; a scannerlocated within the dispensing machine and configured to scan each of theplurality of locations; and a control module to receive a signal fromthe scanner indicating the location of each of the differentmedications; wherein after the dispensing machine has been closed, thescanner automatically scans each of the locations within the dispensingmachine to verify and update the location of each of the differentmedications in the dispenser.
 2. The system of claim 1, wherein thesystem rescans each location after the medication has been loaded andperforms an update of the position of each medication.
 3. The system ofclaim 1, wherein the medications are stored in the dispensing machine inpre-filled magazines.
 4. The system of claim 3, wherein each of themagazines includes a bar code located on an outboard end of themagazine.
 5. The system of claim 4, wherein the bar code is used toidentify the contents of the specific magazine.
 6. The system of claim1, wherein the control module is configured to receive the signalindicating the location of the each of the medications and store thelocation in a memory.
 7. A method comprising: stocking a plurality ofdifferent medications in a plurality of different locations within adispensing machine; closing the dispensing machine; and the dispensingmachine automatically scanning each of the plurality of differentlocations to verify and update the location of each of the differentmedications in the dispensing machine.
 8. The method of claim 7, whereinstocking a plurality of different medications includes stocking aplurality of pre-filled magazines in a plurality of different locationswithin the dispensing machine.
 9. The method of claim 8, wherein each ofthe pre-filled magazines includes a bar code located on an outboard endof the magazine, the bar code identifying the contents of the magazine.10. The method of claim 7, further comprising sending a signal to acontrol module regarding the location of each of the medications withinthe dispensing machine.
 11. A method comprising: opening a medicationdispensing machine; removing empty magazines from the dispensingmachine; placing filled magazines containing medications in a refilllocations; closing the dispensing machine; and automatically scanningeach magazine to confirm placement and location.
 12. The method of claim11, wherein automatically scanning includes scanning barcodes located atthe front of the magazine.
 13. The method of claim 11, furthercomprising sending to a central server the scanned information so thatinventory control is maintained.